Virginia Lawyers Weekly//May 22, 2023
Virginia Lawyers Weekly//May 22, 2023//
Type of action: Medical malpractice
Injuries alleged: Ruptured ectopic pregnancy; rupture of fallopian tube, hemorrhage in the pelvic cul-de-sac
Date resolved: 11/18/2022
Special damages: $17,285 in medical bills
Verdict or settlement: Settlement
Attorney for plaintiff (and city): Richard M. Reed, Manassas
Description of case: Plaintiff initially presented to defendant’s OBGYN practice in June 2020 for a pregnancy confirmation. The plaintiff initially provided a history of dark brown spotting only when wiping with no heavy flow or passage of tissue. A qualitative HCG (urine pregnancy test) was done and it was positive. Plans were made for a new OB visit in two weeks and a quantitative HCG and progesterone were drawn.
On day two, the plaintiff was called back into the office when her lab tests returned low results for HCG and progesterone. Abdominal and vaginal ultrasounds were performed and found no intrauterine pregnancy. At this visit, the plaintiff was told that “it appeared that she had had an early miscarriage.” On day three, the plaintiff’s HCG was again reported as low, but not significantly lower than the previous day. A pelvic ultrasound was read as “normal pelvic ultrasound.”
On day five, the plaintiff was sent a message through an electronic messaging application informing her that “HCG beginning to come down. Please notify us if bleeding doesn’t stop within a week or so.” The plaintiff was not scheduled for any further follow-up testing or office visits. The plaintiff was not advised at any point that she could be suffering an ectopic pregnancy. The plaintiff was not prescribed any medication during or following her visit with the OB/GYN.
On day 12, the plaintiff presented to an emergency room, complaining of abdominal pain and weakness. An ultrasound was obtained that was read to be suspicious for an ectopic pregnancy with a small amount of hemorrhage in the pelvic cul-de-sac. The plaintiff was taken to surgery where she underwent laparotomy with findings of a ruptured ectopic pregnancy in the fimbriated end of the left tube. The right tube appeared normal and both ovaries were normal. Her post-operative course was benign and she was discharged to home in good condition.
In support of her case, the plaintiff retained a board-certified OB/GYN to testify at trial plaintiff’s expert was expected to testify that given the plaintiff’s history, the diagnosis of possible ectopic pregnancy should have been recognized and investigated. Plaintiff’s expert was expected to testify that he found no indication in the records that such was entertained or pursued.
Plaintiff’s expert was expected to testify that the appropriate testing regimen once an ectopic pregnancy is suspected is to perform serial quantitative HCG determinations every 2-3 days to determine if the values are rising or falling. If HCG values are continuing to rise and no intrauterine pregnancy is seen, there is a high probability that an ectopic pregnancy is present. The plaintiff should have been apprised of this risk and advised as to the need for close monitoring and treatment if necessary.
Plaintiff’s expert was expected to testify that given the above, defendant should have given the plaintiff the choice of the mode of treatment, assuming she met the criteria for the use of Methotrexate. These criteria would be presumptive ectopic, or unruptured ectopic 5 cm or less in diameter and HCG less than 10,000. Plaintiff’s expert was also expected to testify that an alternative form of treatment is to perform a laparoscopy.
Plaintiff’s expert was expected to testify that had the unruptured ectopic pregnancy been diagnosed in a timely manner, plaintiff could have been spared the tubal rupture, hemorrhage, and laparotomy she underwent. Based upon the lack of indicated serial diagnostic testing, failure to document whether defendant warned plaintiff of the possible dangers of an ectopic pregnancy, and inadequate follow-up by defendant, plaintiff’s expert was expected to testify that defendant’s care for plaintiff fell below the standard of care expected from a board-certified gynecologist.
Plaintiff’s expert was expected to testify that the dangers of ectopic pregnancy are tubal rupture and subsequent hemorrhage. Plaintiff’s expert was expected to testify that ectopic pregnancies do not resolve themselves. Plaintiff’s expert was further expected to testify that ectopic pregnancy is the leading cause of death in the first trimester of pregnancy. Plaintiff’s expert was further expected to testify that an intra peritoneal hemorrhage is exquisitely painful.
Plaintiff’s counsel Richard M. Reed provided case information.